Mallam Kiran Kumar, Batchu Soyal Rao

BACKGROUND Skeletally immature femoral shaft fractures are relatively uncommon but serious injuries can disrupt the lives of children and their parents and can result in significant long-term disability. Management of femoral diaphyseal fractures in the age group of 6-14 years is controversial and there has been a resurgence worldwide for operative fixation. We wanted to evaluate the efficacy of titanium flexible intramedullary nails for the treatment of femoral shaft fracture in children. METHODS This prospective study was conducted in the Department of Orthopaedics in A.C.S.R. Govt. Medical College from December 2016 to Jan 2019. Thirty-three paediatric patients in age group 6-14 years with closed diaphyseal femoral fractures were stabilized with two titanium nails. All patients were operated under spinal or general anaesthesia and were followed up clinically and radiologically for two years. The final results were evaluated using the criteria of Flynn et al. Technical problems and complications associated with the procedure were also analysed. RESULTS Overall results were excellent in 78.7% (26/33), successful in 15.1% (5/33) and poor in 6.0% (2/33). All the fractures healed with an average time to union of 9.3 weeks (6-12 weeks). Average hospital stay was 8.5 days (7-18 days) and return to school was early with an average of 10 weeks. The soft tissue discomfort and infection near the knee produced by the nails’ ends was the most common problems encountered. Insignificant limb length discrepancy was seen in 3 children, but this remains a potential problem which needs close follow-up until skeletal maturity. There was no delayed union or refractures. CONCLUSIONS Titanium elastic intramedullary nailing is an excellent technique in the surgical treatment of diaphyseal fracture in 6-14 years children. It is safe, less invasive, has fewer complications and avoids prolonged hospitalization with good results and is economical.